Hemostatic and fibrinolytic parameters in survivors of myocardial infarction: a low plasma level of plasmin-alpha 2-antiplasmin complex is an independent predictor of coronary re-events

Abnormalities of coagulation or fibrinolysis play a role in the pathogenesi s of coronary artery disease (CAD). Elevated plasma levels of fibrinogen, v on Willebrand factor antigen, plasminogen activator inhibitor-1 and tissue- type plasminogen activator were reported to be predictive for reinfarction and death in patients with CAD. We investigated the risk for coronary re-ev ents associated with 18 hemostatic and fibrinolytic parameters in a prospec tive study including 200 survivors of myocardial infarction (MI), During a 5-year follow-up, 37 patients suffered one of the following predefined re-e vents: fatal MI (n = 2), non-fatal MI (n = 5), percutaneous transluminal co ronary angioplasty (n = 17) or coronary artery bypass grafting (n = 13). Lo w plasmin-alpha (2)-antiplasmin complex (PAP) plasma levels were associated with an up to fivefold (95% confidence interval, 1.6-15.3) increase in rel ative risk. The association between decreasing PAP levels and coronary re-e vents remained significant (P = 0.004) after correction for possible confou nders using multiple logistic regression analysis. Our data indicate low PA P plasma levels to be associated with subsequent coronary events in patient s with a history of MI. Blood Coagul Fibrinolysis 12:17-24 (C) 2001 Lippinc ott Williams & Wilkins.